腹腔镜同步和内镜-腹腔镜序贯手术治疗胆囊结石合并胆总管结石的疗效观察  

The efficacy comparison of laparoscopic and endoscopic sequential laparoscopic surgery in the treatment of cholecystolithiasis combined with choledocholithiasis

作　　者：宋德静[1] 安东[1] 施开德[1] 丁振[1] 王向阳[1] 蒋维维 

机构地区：[1]安徽医科大学附属巢湖医院肝胆外科,巢湖238000 [2]南京儿童医院普外科

出　　处：《中国临床保健杂志》2017年第4期385-388,共4页Chinese Journal of Clinical Healthcare

基　　金：国家自然科学基金(81100318)

摘　　要：目的对比分析腹腔镜胆囊切除术联合腹腔镜胆总管探查(LC-LCBDE同步)和内镜下十二指肠乳头括约肌切开取石联合腹腔镜胆囊切除术(EST-LC序贯)治疗胆囊结石合并胆总管结石的疗效,旨在为该疾病的临床治疗选择合理的方式。方法回顾性分析采用LC-LCBDE同步治疗及40例采用EST-LC序贯治疗的胆囊结石合并胆总管结石病例资料(共80例)。结果两组均无死亡病例,LC-LCBDE组37例完成手术,3例中转开腹,EST-LC组36例完成序贯治疗手术,4例因内镜下插管失败改行LC-LCBDE。两组手术成功率,手术时间,一次性结石清除率,总并发症相比,差异无统计学意义(P>0.05),住院时间和住院费用方面比较,LC-LCBDE组优于EST-LC组,差异有统计学意义[(10.20±1.23)d比(13.50±2.41)d,t=3.006,P=0.004;(1.93±0.21)万元比(2.67±0.34)万元,t=3.132,P=0.003]。结论在胆囊结石合并胆总管结石的微创治疗中,LC-LCBDE同步治疗在住院时间及住院费用方面优于EST-LC序贯治疗,在技术条件允许下应列为首选。在胆总管相对较细(<0.8 cm),结石位置较低直径较小,可以选择EST-LC序贯治疗。Objective To compare laparoscopic cholecystectomy （LC） combined with laparoscopic common bile duct exploration （ LCBDE, LC-LCBDE ） and endoscopic sphincterotomy （EST） combined with LC （ EST-LC se- quential） curative effect in the treatment of eholeeystolithiasis combined with choledoeholithiasis. Methods The clini- cal data of 80 cases of cholecystolithiasis combined with choledocbolithiasis were analyzed retrospectively,40 cases were treated with LC-LCBDE, the other 40 cases were treated with EST-LC sequential therapy. Results The two groups were no deaths ,37 cases in LC-LCBDE group completed the surgery,3 cases were converted to laparotomy,36 cases in EST- LC group completed the sequential therapy of surgery,4 cases by endoscopic intubation failed received LC-LCBDE, two surgical success rate, operation time, one-time stone clearance rate, total complications compared, no significant differ- ence （P 〉 0.05 ）. The hospitalization time and cost were statistically significant between LC-LCBDE and EST-LC groups （ P 〈 O. 05 ）. Conclusion In the minimally invasive treatment of cholecystolithiasis combined with choledocholithiasis, LC-LCBDE synchronization therapy is superior to EST-LC sequential therapy in hospital stay and hospitalization cost, and thus should be listed as the first choice under the technical condition. For the common bile duct being relatively thinner （ 〈 0.8cm）, the location lower, the stones smaller, EST-LC sequential therapy may be chosen.

关 键 词：胆石 腹腔镜检查 胆道外科手术 

分 类 号：R657.42[医药卫生—外科学]